Learning and transfer of dosage calculations: An evaluation of integrative and computerised instructional approaches

Karen Glaister

Dosage calculations are an essential skill for current nurse practitioners. The challenge for educators is to determine how the learner can be best assisted to learn and apply both general and specific knowledge and skills. This fundamental issue of providing instruction that is meaningful and able to be utilised in another setting is an age-old concern. It can be seen from the posology literature that outcomes from a diversity of instructional attempts have generally been limited. This exploratory field study investigated the effect of specifically prepared instructional approaches upon learning outcome and also the learners' ability to transfer this knowledge. The research is grounded in both transfer of learning and metacognitive-regulatory theory. Three instructional approaches were developed and considered in this study. The computerised learning approach was designed to encourage the low-road of learning providing for automaticity in skill performance. The integrative learning approach incorporated process-oriented instruction to support high-road learning and also repetitive practice to foster the low-road of learning. In addition, it included small group discussion to address the affective component of mathematical phobia often intrinsic to dosage calculations. The third approach combined the strategies provided in both the computerised and integrative learning approaches. Based upon the literature, it was assumed that the integrative approach would be most effective in developing all forms of knowledge, particularly conditional knowledge, and consequently greater performance in far transfer tasks would be evidenced. Furthermore, this effect would be greatest in those learners who reported a negative attitude towards mathematics and mathematical testing and who also lacked self-regulation or external-regulation of learning. The combination of the computerised and integrative approach was expected to enhance the low-road of learning and consequently greater performance on near transfer tasks would be evidenced. Evaluation used a methodological mix of both quantitative and qualitative approaches. The findings were not entirely conclusive, although they did offer some support to the study claims and interesting insight into other issues that need to be accounted for in exploratory field studies of this type. Overall, it appeared that computerised learning might have been more influential in the development of procedural knowledge. However, when learners reported higher levels of negative attitudes towards mathematics and mathematical testing the integrative approach was more effective than the computerised approach in developing procedural knowledge. There was some evidence to suggest that when the learner reported being highly self-regulated or reliant on external-regulation, procedural knowledge development was interfered with when they received the combination of computerised and integrative learning. Although not statistically proven the integrative approach did result in higher scores on conditional knowledge measures in both the first and second post-tests. However when the effect of negative attitudes towards mathematics and mathematical testing was accounted for, then statistical support was evident, indicating that the integrative approach was more effective than the computerised approach under these circumstances. This effect was also noted when the learner reported a medium level of self-regulation. Generally the reported level of metacognitive-regulation did not appear to influence the treatment effects. None of the treatments examined demonstrated greater effectiveness on measures of far transfer. These results support the findings of earlier studies both within the posology and transfer of learning literature asserting that the phenomenon of transfer can be elusive and does not naturally ensue from attempts made to improve upon instructional approaches. However due to institutional constraints the intervention period in the present study was markedly short affecting the integrity of the conceptual framework underlying the study. Despite this, the statistical evidence from the study suggests that both the integrative and computerised learning approach are worthy inclusions into future instructional approaches aimed towards developing competency in dosage calculations.

Learning and transfer of dosage calculations: An evaluation of integrative and computerised instructional approaches

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